Characteristics and outcomes of COVID-19 patients with and without asthma from the United States, South Korea, and Europe

Figures & data

Figure 1. Standardized mean differences of characteristics between diagnosed COVID-19 patients with and without asthma. SMD < 0 = prevalence greater in COVID-19 patients without asthma. SMD > 0 = prevalence greater in COVID-19 patients with asthma. SMD greater or less than 0.1 suggests significant imbalance between groups. Only databases providing sufficient comparative information included. Asthma = Conditions related to asthma. SMD = Standardized mean difference. ILD = Interstitial lung disease. COPD = Chronic obstructive pulmonary disease. CVD = Cerebrovascular disease. CLD = Chronic liver disease. CKD = Chronic kidney disease. AF = Atrial fibrillation. T2DM = Type 2 diabetes mellitus. Asthma = Asthma related comorbidities. Other = Non-asthma related comorbidities. Top row = Name of the database.

Table 1. Prevalence of asthma among the COVID-19 patients in the diagnosed and hospitalized cohorts by country and database.

Cohort	US	US	US	US	US	KR	UK	NL	ES
	CUIMC	HealthVerity	IQVIA OpenClaims	STARR-OMOP	VA-OMOP	HIRA^#	CPRD^¥	IPCI^¥	SIDIAP
Diagnosed COVID-19
Asthma (n)	1338	3367	86328	501	2953	–	343	156	7536
Prevalence (%), 95% CI	15.7	8.7	18.5	15.1	12.0	–	14.7	11.7	6.2
	(13.8–17.7)	(7.8–9.7)	(18.2–18.8)	(12.2–18.5)	(10.9–13.2)		(11.3–18.8)	(7.6–17.7)	(5.7–6.8)
Hospitalized COVID-19
Asthma (n)	479	349	23211	119	607	1560	–	–	952
Prevalence (%), 95% CI	18.4	9.7	17.4	19.3	11.0	20.5	–	–	5.2
	(15.2–22.1)	(7.0–13.3)	(16.9–17.9)	(13.2–27.3)	(8.8–13.7)	(18.6–22.6)			(4.0–6.8)

US = United States. KR = South Korea. ES = Spain. UK = United Kingdom. NL = The Netherlands. (n) =Number.

^#Hospital data only.

^¥Primary care electronic health records only.

Figure 2. Standardized mean differences of characteristics between hospitalized COVID-19 patients with and without asthma. SMD < 0 = prevalence greater in patients without asthma. SMD > 0 = prevalence greater in patients with asthma. SMD greater or less than 0.1 suggests significant imbalance between groups. Only databases providing sufficient comparative information included. Asthma = Conditions related to asthma. SMD = Standardized mean difference. ILD = Interstitial lung disease. COPD = Chronic obstructive pulmonary disease. CVD = Cerebrovascular disease. CLD = Chronic liver disease. CKD = Chronic kidney disease. AF = Atrial fibrillation. T2DM = Type 2 diabetes mellitus. Asthma = asthma related comorbidities. Other = Non-asthma related comorbidities. Top row = Name of the database.

Table 2. Comorbidities across databases in diagnosed and hospitalized COVID-19 patients with and without asthma.

	Diagnosed asthma cohort			Hospitalized asthma cohort			Diagnosed non-asthma cohort			Hospitalized non-asthma cohort
	Median (%)	Range (%)		Median (%)	Range (%)		Median (%)	Range (%)		Median (%)	Range (%)
Characteristic		Lower	Upper		Lower	Upper		Lower	Upper		Lower	Upper
Respiratory/atopy related
Allergic disorder	16	<1.5	35.7	20.4	9.2	86.3	4.2	0.6	14.1	9.9	1.6	61.1
Allergic rhinitis	12.4	<1.5	31.1	17.8	7.7	82.2	3.5	0.5	10.7	8.2	1.2	53.3
Bronchiectasis	0.9	0.5	3.8	1.2	<1.4	4.7	0.3	<0.3	0.9	0.7	0.4	1.9
COPD	5.9	2.3	17.6	14.0	2.8	30.3	4.7	2.1	13.7	13.6	1.4	23.4
Eczema	2.1	<1.5	9	3.3	<1	10.1	0.8	0.6	4.5	2.4	0.3	5.8
Exacerbation of asthma	8.5	1.7	14.0	13.2	1.3	23	–	–	–	–	–	–
Interstitial lung disease	1.3	0.0	1.5	2.9	0.5	3.8	0.5	0.0	1	1.6	0.1	3.0
Obesity	48.1	26.6	63	55.9	35.5	68.5	29.8	11.6	38.9	44.5	17.9	50.9
Sleep apnea	9.9	<1.5	35.5	13.5	0.8	39.4	4.9	<0.3	22.1	6.8	0.3	24.2
Urticaria	1.3	<1.5	5.3	4.4	0.9	18.5	0.5	0.3	3.2	0.5	<0.2	2.8
Cardiometabolic
Atrial fibrillation	5.5	<1.5	8.6	10.4	1.3	14.5	4.3	2.1	9.2	11.2	0.8	16.1
Cardiac arrhythmia	9.0	1.7	14.2	18.7	4.4	24.2	8.7	2.5	14.4	18.5	2.4	24.2
Cerebrovascular disease	3.5	<1.5	4.5	4.9	2.3	7.6	3.1	1.4	4.6	7.1	2.5	8.3
Heart failure	7.8	<1.5	9.1	17.5	5.5	20.9	4.5	1.4	9.6	17	3	19.9
Myocardial infarction	2.3	0.0	3.7	5.4	1.2	8.9	2.4	0.6	3.7	5.3	0.7	7.6
Prevalent heart disease	38.1	12.4	53.7	64.9	19.9	72.8	25	14.6	48.4	48.8	11.2	69.8
Prevalent hypertension	46.9	16	70.4	76	29.6	85.7	33.7	17.2	65.5	62.1	22.4	86.4
Prevalent T2DM	20.6	6.5	41.3	49.7	16.1	58.2	17.7	8.1	36.8	37.8	17.9	55.4
Other
Anxiety	15.1	5.8	44.1	17.2	11.7	38.7	9.8	2.9	30.8	13.6	5.3	30.1
Depression	13.5	4.4	33.1	20.1	5.0	32.1	10.9	4.3	23.2	11.8	4.4	26.1
Prevalent CKD	16	4.5	19.6	25.5	7.6	33	11.9	6.8	21.4	25.7	4.8	38.9
Chronic liver disease	1.3	0.0	4.5	4.6	1.5	8.7	1.1	0.0	4.3	2.3	1.9	7.8

Diagnosed cohort = Persons with a COVID-19 diagnosis or a SARS-CoV-2 positive test with at least 365 days prior observation. Hospitalized cohort = Persons hospitalized with a COVID-19 diagnosis or a SARS-CoV-2 positive test with at least 365 days prior observation. Prevalent = Conditions defined using all person time otherwise within 365 days of index date. Depression = incident depression/major depressive disorder. CKD = Chronic kidney disease. T2DM = Type 2 diabetes mellitus. COPD = Chronic obstructive pulmonary disease.

Table 3. Treatments across databases in patients with asthma 30 days before COVID-19 diagnosis or hospitalization.

	Diagnosed asthma cohort			Hospitalized asthma cohort
	Median (%)	Range (%)		Median (%)	Range (%)
Characteristic		Lower	Upper		Lower	Upper
Asthma management
Systemic corticosteroids	14.6	6.1	17.5	17.9	9.2	19.9
Inhaled corticosteroid	41.4	7.7	55.1	21.6	6.4	71.3
SABA	22.9	8.9	48.4	24.0	2.1	36.9
LABA	19.3	4.8	30.5	12.6	3.2	39.8
LTRA	6.8	3.2	9.4	8.8	3.4	10.5
Methylxanthines	0.1	0.0	1.7	0.2	0.0	2.5
Antibiotics
Beta-lactam penicillins	4.6	1.2	16.3	6.5	<1.4	13.5
Fluoroquinolones	1.5	0.0	3.3	4.5	<1.4	6.9
Macrolides	6.1	<3.2	14.1	10.4	5.4	15.3
Covid-19 symptom management
Acetaminophen	19.8	2.5	31.2	31.3	2.3	46.5
NSAIDs	12.4	3	44	26.8	5.2	49.9
Opioids	7.4	1.7	14.8	13.6	2.9	41.5
Other
Nasal preparations	38.5	8.0	48.7	26.5	9.5	63.6

Diagnosed cohort = Persons with a COVID-19 diagnosis or a SARS-CoV-2 positive test with at least 365 days prior observation. Hospitalized cohort = Persons hospitalized with a COVID-19 diagnosis or a SARS-CoV-2 positive test with at least 365 days prior observation. LTRA = Leukotriene receptor antagonist. Nasal preparations = decongestants and other nasal preparations for topical use (ATC R01A).

Table 4. Outcomes across databases in diagnosed and hospitalized COVID-19 patients with and without asthma.

	Diagnosed asthma cohort			Hospitalized asthma cohort			Diagnosed non-asthma cohort			Hospitalized non-asthma cohort
	Median (%)	Range (%)		Median (%)	Range (%)		Median (%)	Range (%)		Median (%)	Range (%)
Characteristic		Lower	Upper		Lower	Upper		Lower	Upper		Lower	Upper
Death	6.1	2.1	9.6	12.9	3.7	16.9	6.3	4.5	12.5	17.6	2.2	20.7
Intensive services	2.9	0.7	3.7	10.1	2.7	17.6	2.9	0.5	4.0	9.8	1.4	17.9
ARDS	5.2	2.2	11.0	26.1	2.1	39.7	4.8	1.9	12.2	24.5	0.8	44.3
ARFS	2.3	<0.1	7.2	16.0	0.5	29.7	4.1	0.0	9.0	15.2	0.2	35.3
Cardiac arrhythmia	5.5	<1.5	10.0	17.0	3.5	29.7	6.4	1.0	10.3	16.1	1.8	31.9
Heart failure	2.0	0.0	3.9	7.2	3.4	19.8	1.4	0.0	4.0	5.8	2.3	20.4
Myocardial infarction	1.0	0.0	2.3	3.3	1.2	8.4	1.0	<0.3	2.9	3.6	1.9	11
Sepsis	2.1	0.0	6.8	17.2	<0.5	20.5	1.7	0.0	7.9	15.4	0.4	22.8
Bleeding	2.0	0.0	3.1	5.0	2.6	6.8	1.7	0.3	3.5	3.8	2.5	7.8
PE	0.3	0.0	4.1	1.9	<0.3	4.1	0.4	0.1	1.0	1.7	<0.1	3.5
Stroke	0.5	0.0	1.1	2.0	<0.5	2.7	0.1	0.0	0.7	2.2	0.2	3.2

Diagnosed cohort = Persons with a COVID-19 diagnosis or a SARS-CoV-2 positive test with at least 365 days prior observation. Hospitalized cohort = Persons hospitalized with a COVID-19 diagnosis or a SARS-CoV-2 positive test with at least 365 days prior observation. ARDS = Acute respiratory distress syndrome. AFFS = Acute renal failure syndrome. Heart failure = during hospitalization.

Figure 3. Hospitalization, intensive service use and death among COVID-19 patients with asthma (red) compared to those without asthma (blue) by database. Faded lines and boxes = No data available. Hospitalization = On or within 30 days of COVID-19 diagnosis. Dx = Diagnosis. Hosp = Hospitalization. Int. Serv = Intensive services. Top row = Name of the database.